Rhinolaryngoscopic examination of patients with the multiple chemical sensitivity syndrome

Ten patients who met the Cullen case definition for the multiple chemical sensitivity syndrome were evaluated; a history was taken, and physical examination and fiberoptic rhinolaryngoscopy were performed. All patients had an initial chemical exposure, which was followed by multiple physical and mental complaints in response to subsequent exposure to a variety of odorous organic chemicals. Rhinitis was a prominent complaint in nine patients, but one patient denied any nasal symptoms. Rhinolaryngoscopic findings were abnormal in all patients; edema, excessive mucus, a cobblestone appearance of the posterior pharynx and base of the tongue, and mucosal injection were observed frequently. A particularly striking finding was focal areas of blanched mucosa that surrounded a prominent vessel. These results suggest that nasal pathology may be a prominent feature of this disorder.